HomeMy Public PortalAboutAppointment of Campaign TreasurerAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
Elizabeth Davidson
Assistant City. Ctftt - - -:=
. OFELCE USE-ON1
1. CHECK APPROPRIATE BOX(ES):
Er Initial Filing of Form Re -filing to Change: [J Treasurer/Deputy
■
Depository
• Office Q Part
2. Name of Candidate (in this order: First, Middle, Last)
```
` ` -rl-NAn1 A • C 1a- rJ19'I✓e-s
3. Address (include post office box or street, city, state, -zip
code)
11 t39 T+-Coav, t op --
Doty -1d t r -L_ 5Ze.b5
4. Telephone
( 4v'1) `III -487
5. E-mail address
n av% tprilb 5.40-t [. Oz"Y`N
6. Office sought (include district, circuit, group number)
0.__tZ\( C.t71.\t./1►SSIl7Ngi, vc- 0e-Uctta0
-DI STIZAC'r le
7. If a candidate for a nonpartisan office, check if
appiica le:
My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Write -In No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my 0 Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
`.--.811) 'bill V- 1 '1.-aA-P%it.1-- C.W-16% t 1 ESE -12,S
11. Mailing Address
1109 e-CMA CM IZ .`-0 0
12. Telephone
(*V1) 4 06 1
13. City
P -L zt)0
14. County
oub,1.14V
15. State
c-4-
16. Zip Code
3z4335
17. E-mail address
PA spoj dtld3@cymat1. can-,
18. I have designated the following bank as my Primary Depository 0 Secondary Depository
19. Name of Bank 2pt�v._. pc- j,t„A Etaciik
pil.m. tkALLS 139_ 1(M
20. Address 53 $1 tnl . e_ALo i AL, DR0,1t
21. City
D uo
22. County
0 e A4 c)s.
23. State
r --t_..
24. Zip Code
52-500
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT E FACTS STATED IN IT ARE TRUE.
25. Date
6//47/5.
26. Sig a re of Candidate
X �r6. ------s ".- -e":-'7
27. Trea urer's Acceptance of Appointment (fill in th blanks and check the apprep ate block)
I r-P)M110 % -INIAIZA N.1- C-AA)AS -5 , do hereby accept the appointment
(Please
designated above as:
\e,11to\ tS
Print or Type Name)
II Campaign Treasurer Deputy Treasurer.
X v,..,..-�5. ( r_-
----
Date Signature of Campaign Treas rer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.G.